"Self Control in an Age of Excess" By Allen Weiss, MD, MBA, President and CEO

Self Control in an Age of Excess

March 1, 2011 - The esteemed political columnist, George Will recently shared his opinions in the Washington Post. Hedescribed America as “a giant all you can eat buffet” offering calories, credit, drugs, sex, and other intoxicants in excess.

“Affluenza” is a new term for a potential disease in America where we have had too much affluence and freedom without the necessary discipline to control our appetites. We have so many attractive short term options coupled with a growing need for instant gratification, that submission to temptation overwhelms our ability to control ourselves.

One of the respected and well read NCH Healthcare Board members recommended an interesting book called We Have Met the Enemy: Self-Control in an Age of Excess by Daniel Akst. The author points out obvious changes in availability of goods and supplies with many nearby stores being open 24/7 (think Wal-Mart). With a plastic credit card, go ahead and spend more than you can afford, on things you may not even need. The temptation is too great for so many of us.

Information on the internet is also instantaneous and many forms of communication have degenerated from the well-written letter to the instant text message. In the past, it was quite different. Mark Twain allegedly said to his sister, “I have written you a long letter because I didn't have a chance to write a short one.”

The health consequences of our “instant gratification society” are significant, including the few excerpted below from Daniel Akst:

“Consider tobacco; if we could get every American to stop smoking, we'd save an estimated 467,000 lives annually. Ending high blood pressure (much of it arising from unhealthy lifestyles) would save 395,000. And if we could get everybody to slim down to an appropriate body weight, we'd save 216,000.

“These numbers come from a groundbreaking study, The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary Lifestyle, and Metabolic Risk Factors…[which] looked at twelve behavioral risk factors, including smoking drinking, being overweight, having high blood pressure, and being physically inactive. Because of some serious overlap, you can't just tote up all the lives that could be saved from each; obesity, for instance causes a lot of hypertension. But Dr. Majid Ezzati, a Harvard School of Public Health professor who coauthored the report, stated that if you net out the double counting, more than a million people die annual from the dirty dozen behaviors….

“One estimate is that Americans' per capita caloric intake has increased 22 percent since 1980, and the number of diabetics has more than quadrupled.” The gene contributing to the rise in diabetes has become more prevalent as diabetics—since the discovery of insulin in 1929—now survive to their reproductive years. The wonderful use of insulin has had this paradoxical effect which we, objectively, cannot blame solely on overeating.

“Put more starkly: of the 2.5 million deaths that occur annually in America, something approaching half could be prevented—delayed really, but by many years—if people somehow managed to lead healthier lives….

“…The latest estimate, also from a study done at Harvard, is that medical coverage for all might save 45,000 lives annually—a drop in the bucket by comparison….”

We live in a wonderful nation which has so many opportunities. By thinking, behaving, planning, and executing long term we will continue to be innovation, successful, healthy, and prosperous. On the other hand, by indulging, acting impulsively, and procrastinating we will fall behind in a globally-competitive economy.

An interesting question—with a still-to-be determined answer—is whether the citizens of other countries, as they become more successful, will suffer from “affluenza” too. We live in an exciting time with real opportunity. Did our recent change in economic fortune alter our behavior for the better? Stay tune; we'll see.

Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.